Primary care sports med compensation

[sportsmed123]

I was surprised to see sports medicine compensation relatively low compared to some of the other "primary care" subspecialty clinic settings. Why do you think this is? Compared to a field like A&I, which can have starting salaries easily in the 200s-350s range, sports medicine has many more billable procedures. Is it because many sports med doctors aren't doing many in office ultrasounds and injections? There's also potential prp and stem cell use (in the right patients). Another possibility is maybe in sports med clinics you can't see as many patients in the day? Theories/thoughts?

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[deleted87716]

Where did you see it?

 

[sportsmed123]

Where did I see salaries? Both from medscape/AMSSM surveys and friends going into specialties. I know the surveys can be flawed with reporting bias but this seems to be backed from job offerings I have heard about through friends/colleagues.

 

[deleted87716]

Post links, if possible.

I've never seen any sports med salary surveys that were less than FM, but anything's possible.

Our sports med folks generally do better than the average FM doc in our group. The main driver is probably procedures, as well as volume (they can see more patients in a typical office day, as most are focused visits).

 

[sportsmed123]

Sorry, didn't mean standard primary care, but primary care specialty settings.....such as A&I, rheum, endocrine, etc.

 

[Sportsbound]

Yeah, I've wondered the exact same thing. I don't think it's a numbers game since you can see plenty of patients in a sports clinic, as blue dog stated. I'd be interested in hearing people's responses also. Maybe many of the responders to the survey didn't do many procedures. Keep in mind bedside ultrasound is still a relatively new modality for some specialties.

 

[j4pac]

Couldn't it be that you can only earn what your employer is willing to pay? Not many people own their own practices anymore. Employers (either run by hospitals or Orthopods) could have just set the market so that Sports Meds doc make just a little bit more than FPs. There isn't a shortage of applicants, so why not?

This is likely a big reason why PM&R Sports Med trained docs make more. Part of it could be the number and types of procedures...but I think a bigger part could be price fixing.

 

[deleted87716]

Sorry, didn't mean standard primary care, but primary care specialty settings.....such as A&I, rheum, endocrine, etc.

There's no such thing as "primary care specialty settings." The fields you mentioned aren't primary care. They're specialties.

 

[sportsmed123]

It has become an ambiguous term. Sports medicine is a specialty but still is designated as "Primary care sports medicine". Though I was referring to office only based physicians with little to no procedures.

 

[sportsmed123]

Couldn't it be that you can only earn what your employer is willing to pay? Not many people own their own practices anymore. Employers (either run by hospitals or Orthopods) could have just set the market so that Sports Meds doc make just a little bit more than FPs. There isn't a shortage of applicants, so why not?

This is likely a big reason why PM&R Sports Med trained docs make more. Part of it could be the number and types of procedures...but I think a bigger part could be price fixing.

I wasn't aware there was a large salary discrepancy between PMR sports docs and PCSM docs. Possibly the EMGs since they seem to do them on many patients that come in with various pains? If this is the main factor, a primary care sports physician could simply get credentialed in EMGs if they had no exposure in their fellowship. Not sure how much they would be serving an advantage to their patients by doing this but if it was simply to generate more revenue, it would be an option.

 

[j4pac]

I wasn't aware there was a large salary discrepancy between PMR sports docs and PCSM docs. Possibly the EMGs since they seem to do them on many patients that come in with various pains? If this is the main factor, a primary care sports physician could simply get credentialed in EMGs if they had no exposure in their fellowship. Not sure how much they would be serving an advantage to their patients by doing this but if it was simply to generate more revenue, it would be an option.

EMGs could make up the difference...but maybe not. Since most physicians work for companies, they are paid salary. Some may have perks to meeting certain productivity measures, but from what I understand, that is not the primary way that physicians get paid.

It's the responsibility of an employee to make as high of a salary as possible, while it's the responsibility of the employer to pay the employee as low as possible. Somehow, some way, a number in the middle is met. The number is partly due to how much the provider brings in, but I think a bigger factor is market forces. If there are TONS of Sports Med trained physician and the market is saturated, the employer can pay an incoming Sports Med doc less. This is why physicians make less in NYC than in the Midwest and South (especially when taking into account cost of living). It has nothing to do with the ICD codes, procedure codes, etc. It has to do with market forces.

 

[Sportsbound]

EMGs could make up the difference...but maybe not. Since most physicians work for companies, they are paid salary. Some may have perks to meeting certain productivity measures, but from what I understand, that is not the primary way that physicians get paid.

It's the responsibility of an employee to make as high of a salary as possible, while it's the responsibility of the employer to pay the employee as low as possible. Somehow, some way, a number in the middle is met. The number is partly due to how much the provider brings in, but I think a bigger factor is market forces. If there are TONS of Sports Med trained physician and the market is saturated, the employer can pay an incoming Sports Med doc less. This is why physicians make less in NYC than in the Midwest and South (especially when taking into account cost of living). It has nothing to do with the ICD codes, procedure codes, etc. It has to do with market forces.

Good point. So do you think the salary discrepancy between family med-sports trained and PMR-sports med raises from the fact that PMR folk are more likely to have their own clinic, whereas PCSM folk tend to work more with ortho groups?

 

[deleted87716]

It has become an ambiguous term.

Only to people who don't know what it means.

Primary care "provides definitive care to the undifferentiated patient at the point of first contact and takes continuing responsibility for providing the patient's care." http://www.aafp.org/about/policies/all/primary-care.html

Sports medicine is a specialty but still is designated as "Primary care sports medicine". Though I was referring to office only based physicians with little to no procedures.

"Primary care sports medicine" is correct if the physician has been trained in primary care (e.g., FM with a sports medicine fellowship). However, many sports medicine folks end up focusing solely on sports medicine, and stop practicing primary care altogether.

Emergency medicine, rheumatology, and endocrinology are NOT primary care fields.

 

[septoplasty]

Can anyone PM the pdf's from AMSSM? My membership lapsed and I don't wanna renew until I start fellowship in July.

I'm trying to work on a little article for our current residents who are interested in numbers, to determine how many years out after fellowship/residency there will be a change in additional compensation...

 

[cbest]

I wasn't aware there was a large salary discrepancy between PMR sports docs and PCSM docs. Possibly the EMGs since they seem to do them on many patients that come in with various pains? If this is the main factor, a primary care sports physician could simply get credentialed in EMGs if they had no exposure in their fellowship. Not sure how much they would be serving an advantage to their patients by doing this but if it was simply to generate more revenue, it would be an option.

And how might one become credentialed to do EMGs if one has not been properly trained how to do them? Please don't think that a physician outside of physiatry and/or neurology has the knowledge and skill to properly and accurately perform electrodiagnostic studies. It's other specialties and chiropractors who perform brutal studies that provide no diagnostic information but still bill for the studies that led to payments for EMG getting slashed. Please don't continue this trend in the name of the almighty dollar!

 

[j4pac]

Good point. So do you think the salary discrepancy between family med-sports trained and PMR-sports med raises from the fact that PMR folk are more likely to have their own clinic, whereas PCSM folk tend to work more with ortho groups?

That's a good point, and it probably holds lot of truth. From the day you step foot into a PM&R residency you are knees deep in MSK. I'm going to be entering PGY-2 next year and I already have the ability to define my MSK practice. That would likely not occur if I did FP, because SM is not a guarantee. My scope of practice isn't going to be substantially different with or without a Sports Med fellowship...so I can afford to look ahead.

Not to mention that the percentage of PM&R docs go into outpatient MSK is substantial, versus a very small percentage of FPs. This can be pretty important in regards to knowing others who own practices. I have two others from my med school class who went into PM&R...both started their own outpatient MSK practices without fellowship. I'm going to feel confident starting my own MSK practice, primarily because I know tons of people who have laid the foundation for me.

 

[sportsmed123]

..

 

[sportsmed123]

And how might one become credentialed to do EMGs if one has not been properly trained how to do them? Please don't think that a physician outside of physiatry and/or neurology has the knowledge and skill to properly and accurately perform electrodiagnostic studies. It's other specialties and chiropractors who perform brutal studies that provide no diagnostic information but still bill for the studies that led to payments for EMG getting slashed. Please don't continue this trend in the name of the almighty dollar!

And please do not make the mistake of thinking the only medical knowledge you will have has to be obtained in residency. Experience and training outside of residency/fellowships plays a large role in medical practice. If you believe this be untrue, try telling that to a laparoscopic surgeon who learned this all outside of residency (who trained prior to this being incorporated into the curriculum) or an ER physician who learned the bedside ulrasound in weeklong workshops.

 

[cbest]

Agreed that many skills can be learned and added after training but there needs to be a baseline knowledge and skill with EMG that neither primary care residencies nor sports medicine fellowships provide that allows people to build an EMG practice. For the sake of proper diagnosis, please don't kid yourself into thinking you can provide good care with EMG with a weekend course.

 

[j4pac]

And please do not make the mistake of thinking the only medical knowledge you will have has to be obtained in residency. Experience and training outside of residency/fellowships plays a large role in medical practice. If you believe this be untrue, try telling that to a laparoscopic surgeon who learned this all outside of residency (who trained prior to this being incorporated into the curriculum) or an ER physician who learned the bedside ulrasound in weeklong workshops.

EMG is a SIGNIFICANT portion of PM&R training. Its one thing to know how to use the machine, but it's a completely different thing to know how you use the EMG/NCS as part of medical decision making. I'm sure I can learn to drill into a bone in a weeklong course. That doesn't mean I should be credentialed to do knee replacements!

 

[sportsmed123]

Agreed that many skills can be learned and added after training but there needs to be a baseline knowledge and skill with EMG that neither primary care residencies nor sports medicine fellowships provide that allows people to build an EMG practice. For the sake of proper diagnosis, please don't kid yourself into thinking you can provide good care with EMG with a weekend course.

Please reread my message. I never said anything about a weekend workshop. I mentioned weeklong workshop"S"....as in more than one. As with the other specific examples I mentioned, after the didactics, multiple procedures must be peer reviewed and in the presence of someone already qualified/credentialed. For ultrasound credentialling, it's 250 peer reviewed cases. (I'm not saying 250 is a magic blanket number for all procedures either) No one here is talking about weekend courses....relax and can we please redirect the conversation to the thread topic?

 

[j4pac]

Please reread my message. I never said anything about a weekend workshop. I mentioned weeklong workshop"S"....as in more than one. As with the other specific examples I mentioned, after the didactics, multiple procedures must be peer reviewed and in the presence of someone already qualified/credentialed. For ultrasound credentialling, it's 250 peer reviewed cases. (I'm not saying 250 is a magic blanket number for all procedures either) No one here is talking about weekend courses....relax and can we please redirect the conversation to the thread topic?

There is an EMG fellowship if you're interested.

 

[Freezeout]

There is an EMG fellowship if you're interested.

I'd be interested to learn more about this opportunity. Could you link some or just point me in the direction of info?

 

[j4pac]

I'd be interested to learn more about this opportunity. Could you link some or just point me in the direction of info?

I just looked into it. I'm pretty sure that you have to be either PM&R or Neurology to be eligible. I'm not sure that a board certified/eligible Sports Med doc could qualify. I guess you could contact the boards if you really want EMG to be apart of your scope of practice. I doubt it would be worth it financially to take the one-year dip in pay unless you supplement with moonlighting, if allowed.

American Board of Electrodiagnostic medicine (ABEM): http://www.abemexam.org/getmedia/84...d5ad74/2015-Candidate-Information-Packet.aspx

American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM): http://www.aanem.org/About

Keep in mind that VERY few PM&R docs are interested in EMG fellowships because the training in residency is all you really need unless you want more exposure in rare disease. EMG fellowships are more beneficial to Neurologists who don't get 200+ EMGs through their training very often.

 

[Sportsbound]

And please do not make the mistake of thinking the only medical knowledge you will have has to be obtained in residency. Experience and training outside of residency/fellowships plays a large role in medical practice. If you believe this be untrue, try telling that to a laparoscopic surgeon who learned this all outside of residency (who trained prior to this being incorporated into the curriculum) or an ER physician who learned the bedside ulrasound in weeklong workshops.

True to a certain extent, and even if that is true, it doesn't mean the reimbursers will agree. Many surgeons performing arthroscopic procedures were trained post residency and arguably one does not need 5 years of gen surgery to do these. Though that doesn't mean we will ever get to do these.....unfortunately.